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How technology is helping India move toward smart service delivery

eVIN is a mobile- and cloud-based application that allows cold chain handlers to update information on vaccine stocks after every immunization session. These updates give health officials an immediate look at vaccine stocks and flows, reducing wastage. Photo:UNDP India/Prashanth Vishwanathan

An innovation being rolled out by India’s Ministry of Health and Family Welfare is making the jobs of thousands of health care workers across the country more efficient and helping to secure the future of millions of women and children.

In 2015, India launched eVIN, or electronic vaccine intelligence network — a smart, easy-to-use technology aimed at digitizing vaccine stocks in the country. It’s no small ask in a nation with the largest and most ambitious immunization program in the world — aiming to immunize some 156 million women and children each year.

India’s immunization program is not without its challenges. The country’s vast and diverse terrain makes reaching the poorest and most vulnerable a monumental effort. Perhaps the biggest challenge is the absence of real-time information on vaccine stocks and flows, so that health officials are able to make quick and informed decisions.

Recognizing the need for a smart vaccine logistics system that could ensure vaccines are available at the accurate location and time and in the required quantity, the government of India turned to technology to bridge this gap. Implemented in collaboration with theUnited Nations Development Programme, eVIN is a mobile- and cloud-based application that allows cold chain handlers to update information on vaccine stocks after every immunization session. These updates are stored on a cloud server that gives health officials an immediate look at vaccine stocks and flows. It helps officials course correct, reducing wastage and empowering health workers.

But eVIN is more than just a mobile application. It addresses the three ingredients critical to any successful service delivery transformation: people, processes and technology. At the forefront of India’s immunization efforts are thousands of cold chain handlers. Each roll-out of the technology is accompanied by training, sometimes with personal attention, to build confidence in the technology among frontline health workers.

Dr. Nandini Pathak, a district immunization officer from Madhya Pradesh, echoes the challenge. “Fifty percent of our cold chain handlers are above the age of 50 and many had never used a smartphone before,” she said, adding that the app’s simplicity has led to 100 percent compliance with entry recording. “Real-time visibility of stocks and flows has transformed vaccine logistics management. It is strengthening a cadre of health officials at all levels of governance across the country entrusted with delivering 650 million doses of life-saving vaccines.”

Low-cost, temperature loggers fitted with a SIM, which does not require electricity or internet connectivity, have helped address another critical challenge in service delivery — the impact of power cuts, particularly critical for vaccines that have to be stored at the correct temperatures to ensure efficacy and potency. Kusum Lata Rao, a cold chain handler from Udaipur, does not have to worry when she leaves work. “Earlier I would only find out about a power cut when I came into office. Now I get SMS alerts on any temperature abnormality and so I can take immediate action.”

Financing India’s innovative technology

It is estimated that the world faces a $2.5 trillion annual funding gap in achieving the Sustainable Development Goals. Innovative financing mechanisms that include blended finance are required to mobilize and direct funding where it is needed most. India’s experience with eVIN is perhaps one of the earliest examples of success. Financing fromGavi, The Vaccine Alliance, helped develop eVIN and has been catalytic. As eVIN is being rolled out by the central government in 12 states — representing more than 60 percent of the target population — running the technology beyond the initial implementation is now being embedded in the budgets of state governments. The cost of eVIN is a mere fraction of what India invests each year in procuring vaccines.

Early results have been tremendous, with states reporting the savings of millions of dollars. In essence, eVIN pays for itself, guaranteeing high-quality security for vaccines and triggering its own sustainability. But looking beyond finance, eVIN provides a successful example of what can happen when government and other stakeholders — including donors, private sector entities, multilateral agencies and civil society organizations — come together to effectively leverage health financing.

A recent report by the U.N. secretary-general notes that “in promising to leave no one behind, the SDGs challenge policymakers, development practitioners and multilateral bodies to look far more deeply at data and the people behind the aggregated statistics … Walking the talk on ‘leaving no one behind’ will imply interrogating national averages and country typologies based on national income through reliable disaggregated data and a stronger focus on ending exclusion.”

With more than 80 million temperature samples and 2 million online transactions logged into its server every month, eVIN is a warehouse of big data, encouraging transparency, accountability and perhaps, most importantly, providing policymakers the tools they need to ensure equity in service delivery.

Even as eVIN’s rollout across India continues, what is clear is that the Indian government has developed a transformative model that can go well beyond vaccine logistics and be adapted to virtually any other critical service delivery. It demonstrates that when you combine low-cost, smart technology at the last mile with building capacities of those entrusted with service delivery, you can create something that is capable of truly ensuring no one is left behind. India is on an exciting journey, using technology to transform the way it delivers services, moving one e-step closer to its national vision.

It is also showing the world how the “three Ps” of the global agenda can be achieved through a commitment to people (saving lives), planet (robust supply chains), and prosperity (healthy children, healthy futures). The future is in data. For policymakers, investments in big data and digitization of the last mile is the best way we will achieve our global vision to “leave no one behind.”

About the author

Goal 3

The Sustainable Development Goals make a bold commitment to end the epidemics of AIDS, tuberculosis, malaria and other communicable diseases by 2030. The aim of Goal 3 is to achieve universal health coverage, and provide access to safe and affordable medicines and vaccines for all. Supporting research and development for vaccines is an essential part of this process.